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Thyroid Disorders and Diabetes

by Patricia Wu, MD

An elevated TSH level accompanied by normal thyroid hormone levels is known as subclinical hypothyroidism. People with subclinical hypothyroidism often do not have any symptoms. However, they do face the increased risks of cardiovascular disease associated with hypothyroidism, due to the abnormalities in blood lipid levels. Some doctors have even suggested that a TSH level in the upper-normal range (2.5–4.0 mU/ml) should be considered as evolving thyroid failure.

Thyroid antibodies that are produced in autoimmune thyroid diseases can also be measured by blood testing. The presence of these antibodies can help determine the underlying cause of thyroid disorder. The most specific antibody test is called the anti-TPO antibody test.

Treatment of thyroid disease
Nearly all thyroid diseases are treatable. Hypothyroidism and hyperthyroidism often require long-term or lifelong treatment, depending on the specifics of the diagnosis.

Hypothyroidism. The treatment for hypothyroidism is to replace the missing thyroid hormone. The most common form of thyroid hormone is a synthetic derivative, levothyroxine, which is usually taken as one pill daily. This is a simple yet very effective treatment of hypothyroidism. Once the treatment is started, TSH testing every two or three months is necessary to adjust to the correct dose. When a stable dose is achieved, annual TSH testing is generally adequate for monitoring purposes.

The symptoms of hypothyroidism may take several months of therapy to resolve. Often, lifelong treatment is necessary. Natural thyroid extract derived from animal sources is a less commonly used form of thyroid replacement and has the disadvantage of inconsistent dosage that varies from one batch of pills to another.

Certain supplements, including iron supplements, calcium supplements, and multivitamins that contain iron or calcium, can interfere with the absorption of thyroxine. For this reason, these pills should be taken at least two hours apart from thyroxine. In addition, it’s a good idea to let your physician know of any supplements or other medicines you take in addition to levothyroxine.

Hyperthyroidism. There are several options for treatment of hyperthyroidism, with the choice dependent on the cause of the disorder; it must be individually determined. Long-term oral antithyroid medicines such as methimazole (Tapazole) and propylthiouracil (PTU) are effective in controlling the production of thyroid hormone. Regular blood test monitoring is necessary throughout the course of treatment.

Radioactive iodine therapy is the most common treatment used in the United States for hyperthyroidism. It has a very high cure rate but often results in permanent hypothyroidism. Surgery offers an alternative, particularly in people with very large goiters. All these treatments are effective in controlling or curing hyperthyroidism.

Importance of screening
Abnormal thyroid function can have a major impact on diabetes control and increase a person’s risk of developing diabetic complications. Because of the complications that can result from untreated thyroid disorder, regular screening is recommended to allow early detection and treatment. For people with Type 1 diabetes, annual screening is advisable. For people with Type 2 diabetes, screening should be done at the time of diagnosis and then repeated every five years thereafter. The frequency of screening should increase with advancing age, since the incidence of thyroid disorder increases with age. For people over the age of 60, annual screening is recommended.

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